Please Note: These electronic articles are posted for individual, noncommercial use to ensure timely dissemination of scholarly work. They are intended for teaching and training purposes only. Articles should not be reposted or disseminated without permission of the copyright holder. Copyright holders retain all rights as indicated within each article.

Articles are listed below in reverse chronological order. Click on the reference to obtain a copy of the paper.

Helweg-Larsen, M. (2024). The UCLA Multidimensional Condom Attitudes Scale. In C. U. Krägeloh, O. N. Medvedev, & M. Alyami (Eds.). The International Handbook of Behavioral Health Assessment. Springer Nature.

Condoms can prevent both pregnancy and sexually transmitted infections, and it is important to know which specific condom attitudes might be associated with lack of condom use. The 25-item UCLA Multidimensional Condom Attitudes Scale (MCAS) was developed to measure condom attitudes among individuals who do or do not have personal experience using condoms. The MCAS has a 5-factor structure: (1) the reliability and effectiveness of condoms, (2) the sexual pleasure associated with condom use, (3) the stigma associated with people proposing or using condoms, (4) the embarrassment about negotiating and using of condoms, and (5) the embarrassment about purchasing condoms. A smaller subset of items can be used within each factor if 25 items is too many. The MCAS has been translated to more than six languages to date including Chinese, French, and Spanish (Mexican and Columbian). To improve the measurement of condom attitudes, future research should treat condom attitudes as multi-dimensional and consider gendered and cross-cultural approaches to item wording and scale revision.

Helweg-Larsen, M., Peterson, L. M., & DiMuccio, S. H. (2023). Why do U.S. conservatives take fewer COVID-19 precautions?: The role of worry, perceived risk, and governmental trust. Social and Personality Psychology Compass.

Objective: Research suggests a U.S. political ideology gap for taking COVID-19 precautions, but we do not know the role of cognitive risk (assessed here as perceived risk) and affective risk (assessed here as worry) in explaining why conservative Americans participated in fewer recommended precautions (e.g., mask wearing) and whether governmental trust attenuates the effect. We predicted that conservatives (compared with liberals) would take fewer precautions because they thought they were less at risk and were less worried about COVID-19, but that this would be more pronounced for those with low governmental trust. Design: U.S. adults (representative sample: N = 738; Mage = 46.8; 52% women; 78% white) who had not had COVID-19 took two online surveys two weeks apart during the first wave of the pandemic (April 2020). Measures: Participants reported ideology, perceived risk of getting or dying of COVID-19, worry about COVID-19, and trust in the CDC and state officials at baseline. At follow-up, participants reported on COVID-19 precautions: 1) prevention behavior participation (e.g., mask wearing) and 2) behavioral willingness for future behaviors (e.g., vaccination). Results: Politically conservative Americans took fewer precautions due to lower worry (but unexpectedly not due to lower perceived risk). As predicted, when trust was high, the ideology gap was muted for predicting precautions as well as for predicting perceived risk and worry. Conclusion: Conservatives worried less about COVID-19 which predicted fewer precautions, but trust in governmental institutions reduced this ideological gap. Improving governmental trust could be one fruitful path to increasing COVID-19 precautions.

Helweg-Larsen, M., Peterson, L. M., & DiMuccio, S. H. (2022). The interplay between cognitive and affective risks in predicting COVID-19 precautions: A longitudinal representative study of Americans. Psychology and Health, 37(12), 1565-1583. 

Objective: Cognitive risk figures prominently in models predicting health behaviors, but affective risk is also important. We examined the interplay between cognitive risk (personal likelihood of COVID-19 infection or death) and affective risk (worry about COVID-19) in predicting COVID-19 precautionary behaviors. We also examined how outbreak severity bias (overestimation of the severity of COVID-19 in one’s community) predicted these outcomes. Design: In a representative sample of U.S. adults (N = 738; Mage = 46.8; 52% women; 78% white), participants who had not had COVID-19 took two online surveys two weeks apart in April 2020. Main Outcome Measures: We assessed cognitive risk, affective risk, and outbreak severity bias at baseline and at follow-up two precaution variables: prevention behaviors (e.g., social distancing) and behavioral willingness (e.g., vaccinations). Results: Overall, affective risk better predicted precautions than cognitive risk. Moreover, overestimating the severity of the outbreak predicted more affective risk (but not cognitive risk) and in turn more precautions. Additional analyses showed that when affective risk was lower (as opposed to higher) greater cognitive risk and outbreak severity bias both predicted more precautions. Conclusion: These findings illustrate the importance of affective risk and outbreak severity bias in understanding COVID-19 precautionary behavior.

Peterson, L.M., Helweg-Larsen, M., & DiMuccio, S.H. (2021). Descriptive norms and prototypes predict COVID-19 prevention cognitions and behaviors in the United States: Applying the prototype willingness model to pandemic mitigation. Annals of Behavioral Medicine, 55(11), 1089-1103.

Background: Early in the COVID-19 pandemic, prevention behavior adoption occurred in a rapidly changing context. In contrast to expectancy-value theories, the Prototype Willingness Model (PWM) is well-suited for investigating novel and socially-informed behaviors. Purpose: We explored whether PWM social cognitions predicted coronavirus prevention behaviors. Method: A representative sample of United States adults (N = 738; Mage = 46.8; 51.8% women; 78% white; April 2020) who had not had COVID-19 reported PWM predictor variables (perceived vulnerability, prevention descriptive norms, prototypes engaging in prevention behavior, and prevention behavioral intentions). Two weeks later, participants reported their prevention behaviors (handwashing, mask-wearing, social distancing, etc.) and future public health behavioral willingness (contact tracing, temperature checks, etc.). Results: Controlling for putative demographic, past behavior, and coronavirus-contextual (e.g., local infection rates) covariates, mediation models indicated that higher norms and favorable prototypes were associated with greater prevention behavioral intentions, which in turn predicted increased prevention behavior, F(18, 705) = 92.20, p < .001, R2 = .70. Higher norms and favorable prototypes associated both directly and indirectly (through greater prevention behavioral intention) with greater willingness to engage in emerging public health behaviors, F(15, 715) = 21.49, p < .001, R2 = .31. Conclusions: Greater descriptive norms and favorable prototypes for prevention behavior predicted: 1) future prevention behaviors through increases in behavioral intentions and 2) willingness to participate in emerging public health behaviors. These results held across demographic groups, political affiliation, and severity of regional outbreaks. Public health efforts to curb pandemics should highlight normative prevention participation and enhance positive prototypes.

Helweg-Larsen, M., & Tjitra, C. (2021). Does ostracism help smokers quit? Stigma and Health.

Research on the effects of stigmatizing on smokers shows that it is stressful to be reminded of one’s devalued status and stigmatization might help or hinder quitting intentions. In this study, we asked smokers (N = 277) to play an online ball-tossing Cyberball game, ostensibly with non-smoking strangers. Participants were randomly assigned to an ostracism (included or excluded) and concealment (smoking status concealed or revealed) manipulation. We found that exclusion led smokers (directly or via threat appraisals) to be more stressed, cognitively depleted, rejection sensitive, have fewer positive cognitions, see themselves at greater health risk, feel more internalized stigma, and be more interested in quitting, with stronger effects when their smoking status was revealed instead of concealed. These results suggest that concealment is imperfect in protecting against stigma and that exclusion (although stressful and cognitively taxing) can lead to cognitions, attitudes, and intentions helping smokers quit and thus leave their devalued identity. The results do not imply that one ought to stigmatize; stigmatizing smokers might be unethical or create barriers to health-seeking behaviors which could counteract structural efforts to help smokers quit. Future research should examine the role of self-affirmation to increase the effectiveness of health messages perceived as stigmatizing or identity threatening.

Helweg-Larsen, M. (2020). The UCLA multidimensional condom attitudes scale. In R. Milhusen, J. K. Sakaluk, T. D. Fisher, C. M. Davis, & W. L. Yarber (Eds.). Handbook of sexuality-related measures (4th ed., pp. 274-276). New York: Routledge.

The purpose of the UCLA Multidimensional Condom Attitudes Scale (MCAS) is to measure condom attitudes in five independent areas: (1) the reliability and effectiveness
of condoms, (2) the sexual pleasure associated with condom use, (3) the stigma associated with people proposing or using condoms, (4) the embarrassment about negotiating and using of condoms, and (5) the embarrassment about purchasing condoms. The scale can be used with individuals who do and do not have personal experience using condoms. The 25-item MCAS assesses five independent factors associated with condom use and is reliable and valid.

Helweg-Larsen, M., Pyakuryal, M., & Pisinger, C. (2020). Reminders of a stigmatized status might help smokers quit. Stigma and Health, 5(3), 273-283.

As members of a devalued group, it is not surprising that smokers experience stigmatization and discrimination. But it is not clear whether smokers react to these experiences by moving toward or away from their group membership and identity as smokers. Guided by the identity threat model of stigma (Major & O’Brien, 2005), we examined the process of stigmatization and its emotional, cognitive, attitudinal, and behavioral consequences. We experimentally examined how reading a stigmatizing newspaper article or a control article (Experiment 1) and recalling one’s experience with smoking discrimination or a control prompt (Experiment 2) affected smokers’ responses. We also examined the role of cultural contexts (United States vs. Denmark; only in Experiment 1) and smoking identity. In Experiment 1, we used a community sample of smokers from the United States (N = 111) and Denmark (N = 111). We found that reading the stigmatizing article (compared with the control) caused more rejection sensitivity (U.S. participants only) and more intentions to quit smoking (both U.S. and Danish participants) for smokers low in smoking identity. In Experiment 2, we used an online sample of 194 U.S. smokers and found that recalling instances of mistreatment made smokers more stressed, rejection sensitive, and interested in smoking cessation when smokers appraised the stigma cue as threatening. Thus, we generally found that identity threat moved smokers toward leaving their stigmatized group (e.g., quitting smoking) rather than away from it. Our studies highlight the importance of understanding the psychological process by which smokers distance themselves from their spoiled identity.

Helweg-Larsen, M., Sorgen, L., & Pisinger, C. (2019). Does it help smokers if we stigmatize them? A test of the stigma-induced identity threat model among U.S. and Danish smokers. Social Cognition, 37(3), 294-313.

Research shows that smokers feel stigmatized, but does stigmatizing smokers do more harm than good? The model of stigma-induced identity threat was used to experimentally examine how U.S. and Danish smokers respond to stigma-relevant cues. Heavy smokers (112 Americans, 112 Danes) smoked a cigarette while giving a speech that was either video (stigma-visible condition) or audio recorded (stigma-concealed condition). Smokers high in self-concept reacted to the stigma-visible (as opposed to the stigma-concealed) condition with greater physiological reactivity (b = -2.80, p = .05), cognitive depletion (U.S. smokers, b = -0.06, p = .11), self-exempting beliefs (b = 0.32, p < .001), and less interest in stopping smoking (b = 0.28, p = .02). Thus, stigmatization led smokers toward emotional, cognitive, and attitudinal reactions that might make them less likely to quit. Future research should examine when smokers respond to stigmatization by quitting rather than with resistance or indifference.

Schmitt, D. P. et al. (2017). Narcissism and the strategic pursuit of short-term mating: Universal links across 11 world regions of the International Sexuality Description Project-2. Psychological Topics, 26(1), 89-137.

Previous studies have documented links between sub-clinical narcissism and the active pursuit of short-term mating strategies (e.g., unrestricted sociosexuality, marital infidelity, mate poaching). Nearly all of these investigations have relied solely on samples from Western cultures. In the current study, responses from a cross-cultural survey of 30,470 people across 53 nations spanning 11 world regions (North America, Central/South America, Northern Europe, Western Europe, Eastern Europe, Southern Europe, Middle East, Africa, Oceania, Southeast Asia, and East Asia) were used to evaluate whether narcissism (as measured by the Narcissistic Personality Inventory; NPI) was universally associated with short-term mating. Results revealed narcissism scores (including two broad factors and seven traditional facets as measured by the NPI) were functionally equivalent across cultures, reliably associating with key sexual outcomes (e.g., more active pursuit of short-term mating, intimate partner violence, and sexual aggression) and sex-related personality traits (e.g., higher extraversion and openness to experience). Whereas some features of personality (e.g., subjective well-being) were universally associated with socially adaptive facets of Narcissism (e.g., self-sufficiency), most indicators of short-term mating (e.g., unrestricted sociosexuality and marital infidelity) were universally associated with the socially maladaptive facets of narcissism (e.g., exploitativeness). Discussion addresses limitations of these cross-culturally universal findings and presents suggestions for future research into revealing the precise psychological features of narcissism that facilitate the strategic pursuit of short-term mating.

DiMuccio, S. H., Yost, M. R., & Helweg-Larsen, M. (2017). A qualitative analysis of perceptions of precarious manhood in U.S. and Danish men. Psychology of Men & Masculinity, 18(4), 331-340.

Manhood and masculinity have been studied extensively in different academic disciplines and in a variety of contexts. Research shows that becoming (and being) a man in the United States is not an easy task, as manhood is a precarious status that must be actively and publicly achieved and maintained. Previous research has not, to our knowledge, asked men to explain their own perceptions of precariousness nor contrasted modern, industrialized countries that differ on key cultural variables, such as egalitarianism. In the current study, we interviewed college-aged, heterosexual, Caucasian men (9 from the U.S. and 9 from Denmark). We asked how manhood is achieved, how it is maintained, if it can be lost, and the role of masculinity. Results showed similarities in the men’s understanding of manhood (e.g., men in both samples talked about manhood in terms of acting like an adult and protecting others), but the two groups also differed in important ways. The U.S. men described the need to show manhood through athleticism (what the male body ‘does’) and the rejection of femininity whereas the Danish men described the physical embodiment of manhood (what the male body ‘is’) and the importance of having a feminine side. Furthermore, U.S. men contrasted manhood to womanhood whereas Danish men contrasted manhood to boyhood. Based on these conceptualizations, we argue that the Danish men viewed manhood as less precarious than the U.S. men, and conclude that understandings of masculinity and the precariousness of manhood vary cross-culturally and are tied to broader sociocultural values.

Hoorens, V., Van Damme, C., Helweg-Larsen, M., & Sedikides, C. (2016). The hubris hypothesis: The downside of comparative optimism displays. Consciousness and Cognition, 50, 45-55.

According to the hubris hypothesis, observers respond more unfavorably to individuals who express their positive self-views comparatively than to those who express their positive self-views non-comparatively, because observers infer that the former hold a more disparaging view of others and particularly of observers. Two experiments extended the hubris hypothesis in the domain of optimism. Observers attributed less warmth (but not less competence) to, and showed less interest in affiliating with, an individual displaying comparative optimism (the belief that one’s future will be better than others’ future) than with an individual displaying absolute optimism (the belief that one’s future will be good). Observers responded differently to individuals displaying comparative versus absolute optimism, because they inferred that the former held a gloomier view of the observers’ future. Consistent with previous research, observers still attributed more positive traits to a comparative or absolute optimist than to a comparative or absolute pessimist.

Volpp, K. G., Troxel, A. B., Long, J. A., Ibrahim, S. A., Appleby, D., Smith, J. O., Jaskowiak, J., Helweg-Larsen, M., Doshi, J. A., & Kimmel, S. E. (2015). A randomized controlled trial of co-payment elimination: The CHORD trial. American Journal of Managed Care, 21(8), e455-e464. 

Efforts to improve adherence by reducing co-payments through value-based insurance design are become more prevalent despite limited evidence of improved health outcomes. The objective of this study was to determine whether eliminating patient co-payments for blood pressure medications improves blood pressure control. Study design: Randomized controlled trial.
Methods: The Collaboration to Reduce Disparities in Hypertension (CHORD) was a randomized controlled trial with 12 months’ follow-up conducted among patients from the Philadelphia and Pittsburgh Veterans Administration Medical Centers. We enrolled 479 patients with poorly controlled systolic blood pressure. Participants were randomly assigned to: a) receive reductions in co-payments from $8 to $0 per medication per month for each antihypertensive prescription filled, b) a computerized behavioral intervention (CBI), c) both co-pay reduction and CBI, or d) usual care. Our main outcome measure was change in systolic blood pressure from enrollment to 12 months post enrollment. We also measured adherence using the medication possession ratio in a subset of participants.
Results: There were no significant interactions between the co-payment interventions and the CBI interventions. There was no relative difference in the change in medication possession ratio between baseline and 12 months (0.05% and -0.90% in control and incentive groups, respectively; P = .74) or in continuous medication gaps of 30, 60, or 90 days. Blood pressure decreased among all participants, but to a similar degree between the financial incentive and control groups. Systolic pressure within the incentive group dropped 13.2 mm Hg versus 15.2 mm Hg for the control group (difference = 2.0; 95% CI, -2.3 to 6.3; P = .36). The proportion of patients with blood pressure under control at 12 months was 29.5% in the incentive group versus 33.9 in the control group (odds ratio, 0.8; 95% CI, 0.5-1.3; P = .36).
Conclusions: Among patients with poorly controlled blood pressure, financial incentives-as implemented in this trial-that reduced patient cost sharing for blood pressure medications did not improve medication adherence or blood pressure control.

Volpp, K. G., Troxel, A. B., Long, J. A., Ibrahim, S. A., Appleby, D., Smith, J. O., Jaskowiak, J., Helweg-Larsen, M., Doshi, J. A., & Kimmel, S. E. (2015). A randomized controlled trial of negative copayments: The CHORD trial. American Journal of Managed Care, 21(8), e465-e473.

Value-based insurance designs are being widely used. We undertook this study to examine whether lowering copayments for blood pressure medications below $0 improves blood pressure control among patients with poorly controlled hypertension.
Methods: Participants from three Pennsylvania hospitals (n=336) were randomly assigned to (a) get paid $8 per medication per month for filling blood pressure prescriptions, (b) a computerized behavioral intervention (CBI), (c) both payment and CBI, or (d) usual care. The primary outcome was change in blood pressure between baseline and 12 months post-enrollment.
Results: There were no significant interactions between the incentive and the CBI interventions. Blood pressure decreased among all participants, but to a similar degree between the financial incentive and control groups. Systolic blood pressure (SBP) dropped 13.7 mm for the incentive group vs. 10.0 mm for control group (difference = −3.7, 95% CI = [−9.0, 1.6], p=0.17.) The proportion of patients with blood pressure under control 12 months post-enrollment was 35.6% of the incentive vs. 27.7% of the control group (OR = 1.4, 95% CI = [0.8, 2.5]; p=0.19.). Diabetics in the incentive group had an average drop in SBP of 12.7 mm Hg between baseline and 12 months compared to 4.0 mm Hg in the control group (p = 0.02.) Patients without diabetes experienced average SBP reductions of 15.0 mm Hg, compared to 16.3 for control group non-diabetics (p = 0.71).
Conclusions: Among patients with poorly controlled blood pressure, financial incentives did not improve blood pressure control or adherence except among diabetics.

Helweg-Larsen, M. (2014). Does moralization motivate smokers to quit? A longitudinal study of representative samples of smokers in the U.S. and Denmark. Nicotine & Tobacco Research. 16(10), 1379-1386.

Moralization refers to the gradual cultural and personal process by which objects or activities move from being morally neutral to morally contemptuous. Research suggests important cross-cultural differences in how smokers react to being targets of moralization. However, research has not examined whether smokers who agree with moralized sentiments about smoking are more willing to quit or reduce their smoking. In addition, the mediating role of perceived personal risk has not been examined. In this study, representative samples of smokers in Denmark (a smoking lenient country; N = 429) and the United States (a smoking prohibitive country; N = 431) completed surveys 6 months apart. As expected, Danish smokers (compared to U.S. smokers) moralized less and estimated that their personal risk of lung cancer was smaller. Furthermore, moralization at T1 predicted an increase in perceived personal risk at T2 (for Danish and marginally for U.S. smokers), a decrease in smoking behaviors (for Danish smokers only), and an increase in quitting intentions (marginally for Danish smokers only). For Danish smokers, perceived personal risk mediated the relationship between moralization and quitting intentions. Moralization predicted an increase in perceived personal risk, an increase in quitting intentions, and a reduction in smoking behaviors especially for the Danish sample. Future research should examine the effects of moralization in different cultural contexts.

Peterson, L.M., Helweg-Larsen, M., Volpp, K.G., & Kimmel, S.E. (2012). Heart attack risk perception biases among hypertension patients: The role of educational level and worry. Psychology and Health, 27(6), 737-751.

Risk biases such as comparative optimism (thinking one is better off than similar others) and risk inaccuracy (misestimating one’s risk compared to one’s calculated risk) for health outcomes are common. Little research has investigated racial or socioeconomic differences in these risk biases. Results from a survey of individuals with poorly controlled hypertension (N=813) indicated that participants showed (1) comparative optimism for heart attack risk by underestimating their heart attack risk compared to similar others, and (2) risk inaccuracy by overestimating their heart attack risk compared to their calculated heart attack risk. More highly educated participants were more comparatively optimistic because they rated their personal risk as lower; education was not related to risk inaccuracy. Neither race nor the federal poverty level was related to risk biases. Worry partially mediated the relationship between education and personal risk. Results are discussed as they relate to the existing literature on risk perception.

Helweg-Larsen, M., Harding, H. H., & Klein, W. M. (2011). Will I divorce or have a happy marriage?: Gender differences in comparative optimism among U.S. college students. Basic and Applied Social Psychology, 33(2), 157-166.

Previous research shows inconsistent evidence in regard to gender differences in optimism for experiencing a happy marriage or avoiding divorce depending on whether optimism is measured as comparative optimism (thinking you are better off than your peers) or as personal optimism (estimating your own chances). Results from four samples of unmarried college students (N=814) indicated that men exhibited greater comparative optimism than women for having a happy marriage but not for getting divorced. For having a happy marriage and avoiding divorce, men exhibited greater personal optimism relative to women. Experience (with parental divorce) moderated the gender difference in personal optimism and perceived control partially mediated the gender difference in comparative optimism (but only for having a happy marriage) and in personal optimism (for both having a happy marriage and avoiding divorce). Results are discussed as they relate to the existing literatures on risk perception and gender differences in romantic relationships.

Helweg-Larsen, M. (2010). UCLA Multidimensional Condom Attitudes Scale. In Fisher, T. D., Davis, C. M., Yarber, W. L., & Davis. S. L. (Eds.), Handbook of sexuality-related measures (pp. 162-164). New York, NY: Routledge.

The purpose of the UCLA Multidimensional Condom Attitudes Scale (MCAS) is to measure condom attitudes in five independent areas: (a) the reliability and effectiveness of condoms, (b) the sexual pleasure associated with condom use, (c) the stigma associated with people proposing or using condoms, (d) the embarrassment about negotiating and using condoms, and (e) the embarrassment about purchasing condoms. The scale can be used with individuals who do and do not have personal experience with condoms.

Helweg-Larsen, M., Tobias, M. R., & Cerban, B. M. (2010). Risk perception and moralization among smokers in the U.S. and Denmark: A qualitative approach. British Journal of Health Psychology, 15(4), 871-886.

Objectives: The present research explored the role that culture plays in smokers’ description of their risk perceptions and experiences as targets of moralization.
Methods:. We conducted in-depth qualitative interviews with 15 smokers each from Denmark (a smoking-lenient culture) and the USA (a smoking-prohibitive culture).
Results: Smokers said they were well aware of the risks of smoking yet minimized the risks of active and passive smoking; Danes were particularly likely to minimize these risks. Smokers also described many experiences as targets of moralization and accepted some elements of moralized attitudes although overall Danes more strongly rejected moralized opinions. Smokers described adjusting to moralization by changing when and where but not how much they smoked.
Conclusion: It is important to consider cultural influences on moralization and risk perception of smoking.

Harding, H.H. & Helweg-Larsen, M. (2009). Perceived risk for future intimate partner violence among women in a domestic violence shelter. Journal of Family Violence, 24(2), 75-85.

Research investigating women’s risk assessments for intimate partner violence (IPV) shows that women can predict future violence with relative accuracy. Limited research has investigated factors that are associated with perceived risk and the potential behavioral consequences of victim risk perception. Results from a survey of women in a domestic violence shelter (N = 56) indicated that women perceive lower risk of future violence if the abusive relationship were to end and higher risk of violence if it were to continue. Certain abuse experiences were related to elevated perceptions of personal risk for future violence. Further, perceived personal risk predicted the women’s intention to terminate their relationship upon leaving shelter. Results are discussed as they may inform interventions preventing IPV.

Helweg-Larsen, M., & Nielsen, G. A. (2009). Smoking cross-culturally: Risk perceptions among young adults in Denmark and the United States. Psychology & Health, 24(1), 81-93.

Research examining smokers’ understanding of their smoking risk reveals that smokers acknowledge some risk but often deny or minimize personal risk. We examined risk perceptions of lung cancer among smokers and non-smokers in a smoking-lenient (Denmark) and a smoking-prohibitive (the United States) culture. Participants were 275 Danish students attending trade schools (mean age 22.6) and 297 U.S. students attending community colleges in Florida (mean age 23.6). Results revealed cross-cultural differences suggesting that Danish smokers showed greater risk minimization than U.S. smokers. In addition, in both countries the risk of a typical smoker was rated as lower by smokers than non-smokers and smokers rated their personal risk as lower than they rated the risk of the typical smoker. Cross-cultural differences in moralization of smoking might be one explanation for these findings.

Helweg-Larsen, M. & Stancioff, L. M. (2008). Acculturation matters: Risk perceptions of smoking among Bosnian refugees living in the United States. Journal of Immigrant and Minority Health, 10(5), 423-428.

The relationship between acculturation and health behavior change is complex. Little research has focused on acculturation and perceptions of health-related risks. This study investigated acculturation and risk perceptions of heart attack and lung cancer among a group of refugees. Questionnaires were distributed to a sample of Bosnian refugees living in the United States (N = 55). Results indicated that smokers thought they were less at risk than other smokers and no more at risk than non-smokers, whereas non-smokers did not think they were less at risk than other non-smokers. Greater acculturation was associated with greater perception of smokers’ risk of heart attack and lung cancer. Smoking cessation interventions with refugees should incorporate culturally appropriate risk information.

Long, J. A., Helweg-Larsen, M., & Volpp, K. G. M. (2008). Patient opinions regarding pay for performance for patients. Journal of General Internal Medicine, 23(10), 1647-1652.

Background: Pay for performance (P4P) programs have shown only modest improvements in outcomes and do not target patient behaviors. Many large employers and payers are turning to pay for performance for patients (P4P4P) to reduce health costs and improve the health of their covered populations. How these programs may be perceived by patients is unknown.
Objective: To assess patients’ opinion of the acceptability of P4P4P.
Design: Cross-sectional self-administered survey.
Participants: Patients in waiting rooms in two university-based primary care clinics.
Measurements: Participants were asked their opinions about paying people to quit smoking, lose weight, control their blood pressure, or control their diabetes.
Results: Respondents were split on whether P4P4P is desirable. 36-42% thought it was a good/excellent idea to pay smokers to quit smoking, obese people to lose weight, people with hypertension to control their blood pressure, or people with diabetes to control their blood sugar, while 41-44% of the sample thought it was a bad/very bad idea. Smokers and patients who were obese endorsed P4P4P more favorably as a means to achieving tobacco cessation and weight loss than their non-smoking and non-obese counterparts.
Conclusions: Acceptance of paying patients for performance by the general population is equivocal. Establishing the efficacy of paying patients for performance may help it gain wider acceptance.

Helweg-Larsen, M. & LoMonaco, B. L. (2008). Queuing among U2 fans: Reactions to social norm violations. Journal of Applied Social Psychology, 38(9), 2378-2393.

Two experiments examined reactions to line intrusion scenarios among fans of the rock group U2 waiting in overnight queues to obtain desirable concert floor spots. Commitment to the goal, time investment, and ambiguity of the line intrusion scenario were examined. Results showed that the queue was a social system influenced by norms of procedural justice (first-come, first-served). Violations of these norms were upsetting even when the consequences did not directly influence personal outcomes (when line intrusions occurred behind a subject). Greater commitment to the goal led to more severe reactions to norm violations whether the commitment was proximal (having waited in the queue for awhile) or distal (being a committed fan). We discuss research on social norm violations.

Helweg-Larsen, M., Harding, H. G. & Kleinman, K. E. (2008). Risk perceptions of dating violence among college women: The role of experience and depressive symptoms. Journal of Social and Clinical Psychology, 27(6), 551-571.

A great deal of research on risk perceptions has examined predictors of personal and comparative risk judgments but little work has examined predictors such as personal experience and depression with respect to dating violence (DV) risk perceptions. Results from a survey of college women (N=192) indicated that women showed optimistic comparative risk judgments in that they thought their personal risk was lower than other women’s risk of experiencing future DV. Depressive symptoms and greater experience with DV, sexual abuse, and violence socialization were associated with elevated personal risk ratings. The relationship between previous DV experience and personal risk ratings was partially mediated by depressive symptoms. Results are discussed as they relate to the existing literature on risk perceptions.

Gurmankin, A. D., Helweg-Larsen, M., Armstrong, K., Kimmel, S.E., and Volpp, K.G.M. (2005). Comparing the Standard Rating Scale and the Magnifier Scale For Assessing Risk Perceptions. Medical Decision Making, 25(5), 560-570.

Objective: A new risk perception rating scale (“magnifier scale”) was recently developed to reduce elevated perceptions of low-probability health events, but little is known about its performance. The authors tested whether the magnifier scale lowers risk perceptions for low-probability (in 0%–1% magnifying glass section of scale) but not high-probability (>1%) events compared to a standard rating scale (SRS).
Method: In studies 1 (n = 463) and 2 (n = 105), undergraduates completed a survey assessing risk perceptions of high- and low-probability events in a randomized 2X 2 design. In study 1 using the magnifier scale or SRS, numeric risk information provided or not, and in study 2 using the magnifier scale or SRS, high- or low-probability event. In study 3, hypertension patients at the Philadelphia Veterans Affairs hospital completed a similar survey (n = 222) assessing risk perceptions of 2 self-relevant high-probability events—heart attack and stroke—with the magnifier scale or the SRS.
Results: In study 1, when no risk information was provided, risk perceptions for both high- and low-probability events were significantly lower (P < 0.0001) when using the magnifier scale compared to the SRS, but risk perceptions were no different by scale when risk information was provided (interaction term: p = 0.003). In studies 2 and 3, risk perceptions for the high-probability events were significantly lower using the magnifier scale than the SRS (P = 0.015 and P = 0.014, respectively).
Conclusions: The magnifier scale lowered risk perceptions but did so for low- and high-probability events, suggesting that the magnifier scale should not be used for assessments of risk perceptions for high-probability events.

Meloni, A., Helweg-Larsen, M., MacDonald, J. M., & Inoue, A. (2005). A world of their own: Acculturation and views on war and interpersonal violence among adult Mennonites. Psi Chi Journal of Undergraduate Research, 10(2), 49-53.

Research shows that the degree of acculturation may affect individuals’ views within a given culture as more acculturated individuals may hold values that are consistent with those of the given culture. We examined acculturation and attitudes toward war and interpersonal conflict among adult Mennonites. Consistent with predictions, increased acculturation was associated with favorable views about the use of violence in interpersonal conflicts. Unexpectedly, acculturation was not associated with support of war, likely because the data were collected during Gulf War II. Future research on Mennonites and acculturation should consider views on all types of violence, especially use of corporal punishment.

Helweg-Larsen, M., Cunningham, S. J., Carrico, A., & Pergram, A. M. (2004). To nod or not to nod: An observational study of nonverbal communication and status in female and male college students. Psychology of Women Quarterly, 28(4), 358-361.

Gender studies show that men and women communicate using different styles, but may use either gender style if there are situational status differences. Considering the universal gesture of head nodding as a submissive form of expression, this study investigated head nodding by observing male and female college students in positions of subordinate and equal status. We observed head nodding (N = 452) in classroom interactions between professor-student and student-student dyads. Overall, women nodded more than men and students nodded more to professors speaking than peers speaking. In addition, female and male students nodded equally to professors speaking, but men nodded less to peers speaking than did women. Thus, both men and women attended to the status and not the gender of the speaker. Future research using varying contexts should further examine the effects of dominance, context, and gender.

Helweg-Larsen, M., Kjøller, M., & Thoning, H. (2003). Do age and social relations moderate the relationship between self-rated health and mortality among adult Danes? Social Science and Medicine, 57(7), 1237-1247.

It is well-established that self-rated health predicts mortality even after controlling for a wide range of factors. We explored the extent to which age and social relations (structural and functional) influenced the relationship between self-rated health (SRH) and mortality (after 13 years follow-up) in a representative sample of adult Danes (N = 6693). After controlling for socioeconomic status, illness, and lifestyle variables, we found that age moderated the SRH-mortality relationship such that it was present for respondents under 55 but absent for respondents over 56. In addition, weaker structural (but not functional) social relations increased mortality directly but neither structural nor functional social relations moderated the SRH-mortality relationship. We discuss the theoretical and practical implications of these findings.

Shepperd, J. A., Helweg-Larsen, M., & Ortega, L. (2003). Are comparative risk judgments consistent across time and events? Personality and Social Psychology Bulletin, 29(9), 1169-1180.

Research reveals a pervasive optimism in people’s comparative risk judgments such that people believe they are less likely than others to experience negative events. Two studies explored the extent to which people are consistent in their comparative risk judgments across time and events. Both studies found strong evidence for consistency across time and some evidence for consistency across events. The consistency across time and events was moderated by experience. Specifically, when viewed together the studies suggest that experience produces an initial decrease in the consistency of comparative judgments (Study 2), followed by greater consistency in subsequent judgments (Study 1). The discussion focuses on reconciling evidence demonstrating consistency with evidence demonstrating variability.

Klein, C. T. F., & Helweg-Larsen, M. (2002). Perceived control and the optimistic bias: A meta-analytic review. Psychology and Health, 17(4), 437-446.

People consistently believe that negative events are less likely to happen to them than to others. Research suggests a relationship between this optimistic bias and perceived control such that the greater control people perceive over future events, the greater their optimistic bias. We conducted a meta-analysis of 27 independent samples to quantify the size of this relationship and examine what variables moderated the relationship. Greater perceived control was significantly related to greater optimistic bias, but this relationship was moderated by participant nationality, student status, risk status, and the type of optimistic bias measure used. We discuss the findings in the context of primary versus secondary control.

Helweg-Larsen, M., Sadeghian, P., & Webb, M. S. (2002). The stigma of being pessimistically biased. Journal of Social and Clinical Psychology, 21(1), 92-107.

People are stigmatized and socially rejected for a range of deviant appearances and behaviors. This includes the social rejection of people who are depressed or have a pessimistic outlook on life. We examined whether being pessimistically biased (i.e., thinking one’s risk for negative events is greater than that of one’s peers) also leads to social rejection. Two experiments showed that pessimistically biased individuals were less socially accepted and that this lack of acceptance originated in the presumption that pessimistically biased people are also hopeless, sad, and depressed. In general, people are overwhelmingly optimistically biased. This research suggests one potential reason why, namely that pessimistically biased people are stigmatized and socially rejected.

Helweg-Larsen, M. & Shepperd, J. A. (2001). Do moderators of the optimistic bias affect personal or target risk estimates? A review of the literature. Personality and Social Psychology Review, 5(1), 74-95.

The optimistic bias is defined as judging one’s own risk as less than the risk of others.  Researchers have identified numerous personal and situational factors that moderate the extent to which people display the bias.  It is unclear, however, whether these moderators affect the bias by influencing people’s personal risk estimates or their risk estimates for a target.  A review of moderators of the optimistic bias reveals evidence for both influences. Moderators associated with negative affect (negative mood, dysphoria, trait and state anxiety, event severity, and proximity of feedback) and control related moderators (perceived control and prior experience) appear primarily to affect personal risk estimates.  Positive mood affects target risk estimates.  Finally, moderators that surround that comparison process appear to have different effects.  Specifically, the type of comparison target appears to affect target risk estimates, whereas attention to personal risk-related behaviors affects personal risk estimates.

Kjøller, M., & Helweg-Larsen, M. (2000). Suicidal ideation and suicide attempts among adult Danes. Scandinavian Journal of Public Health, 28(1), 54-61.

This study describes the prevalence of suicidal ideation and attempted suicide among adults in Denmark and the proportion of people reporting a suicide attempt that results in contact with the health care system. The data for the 1994 Danish national health interview survey were collected by personal interview and a self-administered questionnaire. A subsample of 1362 individuals participated in the part of the survey addressing suicidal behavior (64% of the random sample). Results show that 6.9% reported having had suicidal thoughts within the past year. Averaging across all age groups the overall prevalence of reporting ever having had a suicide attempt was 3.4% and the one-year prevalence was 0.5%. Suicidal ideation was more prevalent among young people than older people, whereas ever attempted suicide showed no age gradient. Both suicidal ideation and ever attempted suicide were more prevalent among economically inactive people (e.g., unemployed) and among unmarried or divorced people. We estimate that 50-60% of suicide attempts reported in a representative, national survey become known to the health care system.

Helweg-Larsen, M., & Howell, C. (2000) Effects of erotophobia on the persuasiveness of condom advertisements containing strong or weak arguments. Basic and Applied Social Psychology, 22(2), 111-117.

Individual differences in erotophobia affect the way people process sexually related information, such as information concerning safer sex. The current study tests the hypothesis that people who are erotophobic are less likely to take the central route in information processing about sexual material as described by the elaboration likelihood model. Female college students (n = 94) were randomly assigned to view a condom advertisement containing either strong or weak arguments. Consistent with predictions, all women were more persuaded by the advertisement containing strong than weak arguments. However, erotophobic women were also relatively more persuaded by weak arguments than were than were erotophilic women. Erotophobia appears to interfere with central route processing of sexually related messages.

Helweg-Larsen, M. (1999). (The lack of) optimistic biases in response to earthquakes: The role of personal experience. Basic and Applied Social Psychology, 21(2), 119-129.

The tendency to believe that one’s risk is less than that of one’s peers is a well-documented and pervasive tendency. This optimistic bias is reduced in certain circumstances such as when people have personal experience with the event, although the bias may reappear with time. University students who experienced the 1994 Northridge (CA) earthquake were asked one week after the quake about their optimistic biases about earthquakes and a variety of other events. Students were followed every two weeks over the next 5 months. In addition, two new groups of students were surveyed at 2 and 4 months after the earthquake. As expected no optimistic bias for earthquakes was present immediately after the earthquake (but other events did show the bias). Contrary to previous research no bias for earthquakes was present even 5 months after the earthquake. Those who had personal experience with injury or monetary loss as a result of the earthquake showed less optimism about injury in future earthquakes than those with no personal experience of injury or loss. Results are discussed in terms of the moderators of the optimistic bias.

Helweg-Larsen, M. (1999). Students do not overestimate their life expectancy: An alternative demonstration of unique invulnerability. Teaching of Psychology, 26(3), 215-217.

Snyder (1997) offered a demonstration of unique invulnerability (i.e., optimistic bias) in which students overestimated their projected life expectancy.  However, comparison of Snyder’s data with actuarial data for his participants reveals no evidence of an optimistic bias.  I asked students to estimate their life expectancy after being provided with no information, the information Snyder’s students were given, or the actual average life expectancy. Students were consistently accurate in their life expectancy estimates.  I describe an alternative classroom demonstration of unique invulnerability.

LaBranche, E. R., Helweg-Larsen, M., Byrd, C. E., & Choquette, R. A. (1997). To picture or not to picture: Levels of erotophobia and breast self-examination brochure techniques. Journal of Applied Social Psychology, 27(4), 2200-2212.

People’s level of erotophobia influences their acceptance of sexually related situations, including the likelihood of engaging in sexually related health care such as breast self-examinations (BSE). Female college students (n = 61) completed a measure of erotophobia and read a BSE brochure which either did or did not contain instructional photographs showing a woman’s breasts. As hypothesized, women high in erotophobia felt less competent in giving themselves BSE and were less likely to claim that they did things to improve their health when they read the picture brochure compared with the non-picture brochure. In contrast, women low in erotophobia thought that the information was easier to understand and that BSE was more important when they read the picture brochure compared with the non-picture brochure. Implications and limitations of the results are discussed with emphasis on the applied consequences of these findings.

Helweg-Larsen, M., & Collins, B.E. (1997). A social-psychological perspective on education in AIDS prevention. Current Directions in Psychological Science, 6(2), 23-26.

Many AIDS interventions are based on the idea that giving people the facts about transmission of HIV will lead to positive attitudes toward preventive behaviors and ultimately behavior change. However, the route to changes in behaviors does not always pass through the acquisition of knowledge. Three social psychological theories concerning persuasion (elaboration likelihood model of attitude change, theory of planned behavior, and cognitive dissonance theory) are presented that provide theoretical reasons for why information at times does not lead to learning, attitude change, or behavior change. It also shows that behavior change may occur without new knowledge. Providing the facts about disease processes might have negative consequences under certain circumstances, especially if the recipients feel they are already overloaded with such information.

Gibbons, F.X., Helweg-Larsen, M., & Gerrard, M. (1995). Prevalence estimates and adolescent risk behavior: Cross-cultural differences in social influence. Journal of Applied Psychology, 80(1), 107-121.

Prevalence estimates and prototype perceptions related to health risk behaviors were assessed in comparable samples of Danish and American adolescents (ages 13-15 years). Partly on the basis of observation and previous research, the assumption was made that the American sample would report more self-enhancement tendencies than would the Danish sample. Consistent with this assumption, which was supported by the data, 2 hypotheses were tested: (a) The Americans would overestimate the prevalence of the various risk behaviors (among their peers) more so than would the Danes and (b) those estimates would be more closely linked to their own risk behaviors for the American sample. Results supported both hypotheses; motivational explanations were proposed for both effects. In addition, perceptions of the prototypes associated with particular risk behaviors were assessed and were found to predict smoking behavior and willingness to engage in unprotected sexual intercourse for both samples. Implications for the study of adolescent risk behavior are discussed.

Helweg-Larsen, M., & Collins, B.E. (1994). The UCLA multidimensional condom attitudes scale: Documenting the complex determinants of condom use in college students. Health Psychology, 13(3), 224-237. |  cover letter & scale

This article describes the development and validation of the UCLA Multidimensional Condom Attitudes Scale (MCAS). The relationship between the MCAS and gender, sexual experience, intentions to use a condom, and past condom use were assessed. The MCAS has five distinct factors: (a) Reliability and effectiveness of condoms, (b) the sexual Pleasure associated with condom use, (c) the stigma attached to persons who use condoms (Identity Stigma), (d) the Embarrassment About Negotiation and Use of condoms, and (e) the Embarrassment About the Purchase of condoms. The results strongly suggest that condom attitudes are multidimensional and thus cannot meaningfully be summed to a single global score. Results further indicate that men and women hold very different attitudes toward condoms. Implications of scale multidimensionality and directions for future research are discussed.